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Did insurers short HIV patients?

By Jay MacDonald · Bankrate.com
Tuesday, June 3, 2014
Posted: 6 am ET

When the Affordable Care Act was constructed, its core principle was that everyone benefits because it requires as many Americans as possible to jump into the health insurance risk pool. Only in this way are we able to spread the risk among young, old, sick and well alike, to make the cost of coverage affordable for all and thereby enjoy the societal benefits of a healthier nation.

The huge incentive for health insurers, of course, was a once-in-a-lifetime flood of new customers, thanks to the individual mandate, which requires most of us to jump into the health insurance pool or face a tax penalty. More than 8 million Americans did just that during the inaugural open enrollment period that ended March 31, with millions more expected to follow.

Unfortunately, a recent report suggests that the prospect of 30 million uninsured Americans washing up on their doorstep apparently hasn't stopped some insurers from remaining in the shallow end of the risk pool at the expense of one of our most vulnerable groups: people with HIV and AIDS.

© miker/Shutterstock.com

4 insurers singled out

Last week, the AIDS Institute and the National Health Law Program filed a complaint with the Department of Health and Human Services' Office of Civil Rights, accusing Cigna, Humana, Coventry Health Care and Preferred Medical of discriminating against HIV and AIDS patients in Florida by overcharging them for their medications, including generics.

HIV and AIDS medications are notoriously pricey. The most widely used HIV drugs cost $2,400 to $2,948 per monthly supply, and many HIV patients take multiple drugs.

The two advocacy groups found that the insurers' benchmark "silver" plans sold on the Obamacare exchange in Florida were designed so that HIV/AIDS medications were placed in the highest "specialty drug" tier. As a result, Cigna's plan requires HIV/AIDS patients to pick up 40 percent of their drug costs after deductibles, while Humana's silver plan puts 50 percent of the cost on policyholders after they meet their deductible.

The complaint notes that other Florida insurers' plans charge much less. For instance, Florida Blue's plans categorize most HIV drugs in the two lowest drug tiers, requiring co-payments of between $10 and $70.

The advocates claim they can prove that since other insurers did not place HIV/AIDS medications in high-cost tiers, the four insurers in question did so in an attempt to keep HIV/AIDS patients off their plans.

The companies respond

In statements, Cigna, Coventry and Humana say they cover all the necessary HIV drugs and offer multiple plans, including some with higher premiums that offer lower drug cost-sharing ratios. Preferred Medical did not return media inquiries.

National Health Law Program staff attorney Wayne Turner says he fears other insurers will adopt similar plan strategies if they're left unchallenged.

"If health plans are allowed to structure their benefits in such a way that discourages HIV/AIDS patients from enrolling, it'll have a race-to-the-bottom effect," Turner told Florida's Tampa Bay Times. "That's a scary situation, and it's contrary to what the Affordable Care Act is all about."

Here's how Obamacare has benefitted special interest groups.

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